Original article.
To test the use of bornaprine in the hyperhidrosis treatment in the acute phase of spinal cord-injured patients.
Patients with acute spinal cord lesions in the Spinal Unit of Pietra ...Ligure, Savona, Italy.
In 4 years, 12 patients have been treated, for a maximum period of 75 days, with dosages ranging from 2 to 4 mg day(-1).
All of them reported long-lasting subjective benefits, without side effects, even after the interruption of the therapy.
The bornaprine treatment, at 2 or 4 mg day(-1) dosage, has been effective and safe to contrast hyperhidrosis, in the acute phase of spinal cord-injured patients. This positive experience would require additional trials and a larger number of cases to gain a more solid support.
Abstract
Background
Given the problems generated by health care fragmentation, the coordinated provision of health care has become a priority, particularly in Latin America. This communication ...analyses the strategies for improving clinical coordination proposed by primary and secondary care doctors from public health service networks in six countries of the region (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and their changes between 2015 and 2017.
Methods
Two cross-sectional survey-based studies (2015 and 2017) were analysed with application of the COORDENA questionnaire to a total of 4311 primary and secondary care doctors from two public health service networks in each country. A descriptive analysis was carried out, stratified by country and year, of the suggestions proposed in the open question ‘What do you propose to improve clinical coordination between primary and secondary care doctors in the network?
Results
In all countries, the introduction or improvement of strategies and mechanisms that facilitate interaction and mutual knowledge between professionals at different care levels were highlighted, especially joint meetings, direct communication mechanisms (such as telephone and/or e-mail) and strategies to strengthen the use of the referral and counter-referral sheet. Less frequently, other organisational strategies aimed at strengthening the primary care model, improving access to secondary care and coordinating the management level of the network, were also suggested.
Conclusions
The results contribute to generate recommendations for the improvement of clinical coordination in health systems, based on the suggestions of doctors, a perspective that is not usually considered in the design and implementation of interventions in health services. The need to promote strategies based on mutual feedback in the design of public health policies stands out.
Key messages
• The design of effective interventions aimed at improving coordination requires doctors’ participation.
• Strategies based on mutual feedback and communication should be promoted by healthcare organisations to improve clinical coordination.
Abstract
Background
Evaluation of interventions to improve continuity of care across care levels is scarce in Latin America. The
Aim
to analyse the impact of implemented interventions on the ...perception of continuity of care of chronic patients in public health care networks of five LA countries (Brazil, Chile, Colombia, Mexico, and Uruguay).
Methods
Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN) were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying CCAENA questionnaire® to a sample of patients with chronic conditions (392/network; 784/country/year). Result variables: information continuity (exchange of clinical information) and clinical management continuity (repetition of exams, accessibility of primary care (PC) and secondary care (SC), perception of agreement between PC and SC doctors and of collaboration between PC and SC doctors. Descriptive analysis were conducted, and chi-square test was calculated to determine significant changes.
Results
An increase in the perception of continuity of information between care levels was observed in the IN of all countries, but Colombia. Clinical management continuity: decrease in the repetition of exams and increase in accessibility of consultation with the specialist in all countries but Mexico. The accessibility of PC doctor decreased in the IN in all countries. No differences in the perception of agreement between PC and SC doctors regarding diagnosis, treatment and recommendations were found. The perception of collaboration between PC and SC doctors increased in the five countries.
Conclusions
Consistent with expected results, the level of perceived information continuity and clinical management continuity increased in the IN, with differences between countries. Further multivariate analyses will be conducted to explore the differences between the IN and CN.
Key messages
Provides a cross-country comparison of the perception of continuity of care in patients with chronic conditions. Contributes to fill the knowledge gap on the effectiveness of participatory interventions improving continuity of care.
Abstract
Background
Finding new strategies for care integration has become a priority for many health systems in Latin America. Although the implementation of interventions through a participatory ...action research (PAR) approach is considered effective, its application in health services is scarce.
Aim
to analyse impact of PAR interventions on care coordination, and aspects for sustainability and transferability in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay.
Methods
A qualitative, descriptive-interpretative study was conducted in each healthcare network. Focus groups and individual semi-structured interviews were conducted to a criteria sample of Local Steering Committee (29), Platform of professionals (28), professionals (49) y managers (28). A thematic content analysis was conducted, segmented by country and themes. Different interventions were designed and implemented through a PAR process: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a (back) referral form; and an induction program.
Results
Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and administrative coordination. The meetings, alongside the PAR process, helped to improve interaction between professionals, fostering willingness to collaborate. No significant contributions were identified in the remaining interventions due to the low uptake. A necessary condition for the sustainability and replicability of the interventions was that the PAR process had to be used appropriately in a favorable context.
Conclusions
Evidence is provided on the significant contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process.
Key messages
It contributes to fill the gap regarding the impact of PAR interventions on care coordination. A key aspect for impact and sustainability is an adequate use of PAR approach in a favourable context.
Abstract
Background
Despite the effectiveness of Participatory Action Research (PAR) in reducing the gap between evidence and practice, its use to improve care integration is rare. The aim is to ...analyze the factors influencing the implementation of PAR interventions to improve clinical coordination in public health services networks of Brazil, Chile, Colombia, Mexico and Uruguay.
Methods
A qualitative, descriptive-interpretative study was conducted in participating healthcare networks of each country. Focus groups and individual semi-structured interviews were conducted to a criteria sample of participants: members of Local Steering Committee (LSC)(29), professionals’ platform (PP)(28), other professionals (49) and managers(28). Thematic content analysis was performed, segmented by country and themes.
Results
Findings reveal that contextual factors, the PAR process and interventions’ content were determinants in the implementation, interacting over time, and differing among experiences. On the one hand, institutional support (providing the necessary resources) together with the interest of professionals and managers in participating, emerged as influencing factors influenced by other factors related to: the system (alignment with policies; electoral cycle), networks (lack of time due to work overload; precarious employment conditions) and individuals (limited mutual knowledge and mistrust). On the other, some characteristics of the PAR process facilitated institutional support and motivation: professionals’ participation in all activities, design flexibility and shared decision-making - also present when interventions were based on mutual adjustment - the LSC’s leadership and the facilitating role of the research team.
Conclusions
Evidence is provided that when some contextual elements converge the implementation of interventions through PAR processes can turn into a factor of motivation and cohesion, determinant for the adoption of clinical coordination interventions.
Key messages
Contributes to fill the knowledge gap in factors influencing the implementation of PAR interventions in healthcare.
Provides a framework for analysis and recommendations for their implementation.
Abstract
Background
Evaluation of interventions to improve clinical coordination across care levels is scarce in Latin America.
Aim
to evaluate the effectiveness of interventions implemented through ...participatory action research in improving clinical coordination between care levels in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay.
Methods
Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying COORDENA® questionnaire to a sample of primary (PC) and secondary (SC) care doctors (174 doctors/network/year). Designed interventions promoted clinical agreement and communication across levels for patients’ follow-up. Outcome variables: a) intermediate: interactional and organizational factors; b) final: experience of clinical management coordination (care consistency and patients’ follow-up) and general perception of coordination between levels. Poisson regression models were estimated.
Results
Intermediate: interactional factors -personal knowledge and trust on the other care level-increased significantly in Brazil’ and Chile’ INs; and organizational factors -managers’ support- in the INs of Colombia and Mexico. Comparing to CN in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors.
Final: care consistency items -agreement over the treatments- improved in the INs of Brazil, Colombia and Uruguay; and patients’ follow-up in the INs of Chile and Mexico. General perception of clinical coordination increased in the INs of Brazil, Colombia and Mexico. Compared to CN in 2017, only Brazil showed significant differences.
Conclusions
Improvements in intermediate and final care coordination results, consistent with expected results, were observed in all the INs. Reduced implementation time and some process and context factors may have limited their impact.
Key messages
First study assessing the effectiveness of participatory interventions in improving clinical coordination between care levels in public healthcare networks of Latin America.
Results showed changes in the intermediate and final clinical coordination results in the intervention networks. Longer implementation and evaluation times are expected to achieve greater impact.
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